What is Septoplasty and Turbinate Surgery?
 What is Fungal Sinusitis?
 What causes allergies, sinusitis and infections?
 What techniques can I use for allergy prevention?
 What Therapies are available for Allergies
 When should I see a specialist?
 What is Pediatric Sinusitis?
 Are Headaches Common with Sinusitis?
 What is Post-Nasal Drip?
 What causes a stuffy noses & nasal obstructions?
 What causes of taste and smell disorders?
 What are nasal polyps?

When should I see a specialist?
Patients should seek consultation with an Otolaryngic Allergist when:

• The diagnosis of an ENT allergy or the cause of an ENT symptom is uncertain
• When allergy or ear, nose, and throat symptoms are not adequately controlled
• When special diagnostic allergy tests are required
• When specialized treatment, such as allergy shots, are required
• In the presence of other related ENT problems, such as chronic sinusitis, nasal polyps, middle ear fluid, chronic ear infections, deviated septum, voice disorders, or enlarged tonsils or adenoids.
• When allergy symptoms or complications associated with allergy treatments are adversely affecting the quality of life

Pediatric Sinusitis
While small sinuses in the maxillary (cheek) and ethmoid (between the eyes) regions are present at birth, the sinuses in children are not fully developed until their teenage years or early 20s. Unfortunately, children can still suffer from sinusitis, and it may be more difficult to diagnose in children. Due to their immature immune systems, children usually get 6-8 viral infections each year. While some of the symptoms are similar to adults with sinusitis, children may suffer more often from cough, irritability, and swelling around the eyes. Treatment of chronic sinusitis in children is similar to that of adults, beginning with reducing exposure to known environmental allergies and irritants (tobacco smoke, daycare, acid reflux) and progressing to the use of medications. Fortunately, children respond to medical therapy even better than adults with chronic sinusitis. In those rare cases where surgery is needed, an adenoidectomy is often successful as an initial approach. This removes enlarged tissue in the back of the nose that can cause many of the symptoms of chronic sinusitis. FESS is reserved for the most refractory cases.

Headaches and Sinus Disease
Headache is a common problem that is often associated with sinusitis. Unfortunately, sinusitis is only one of a large number of causes for headaches and it may be difficult to determine the exact cause of a patient’s pain. The true cause for a patient’s headache may be difficult to determine, because sometimes headaches occur with sinusitis and sometimes not. Generally, patients with sinus headaches will have other symptoms, such as nasal congestion or thick, discolored drainage and these symptoms will improve with appropriate medical therapy (see above: How is sinusitis diagnosed?). Most often the headaches will be over the areas of the underlying infected sinus (forehead, around/between the eyes, cheek areas). Sinus headaches cause pain as a result of air, pus, and mucus being trapped within the obstructed sinus.

Non-sinus headaches can also occur in similar locations, but they usually will not be accompanied by nasal symptoms. When a headache is the only symptom, it is rarely sinus related and other causes should be looked for, because pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, if patients have undergone unsuccessful treatments for migraine or other headache disorders, consideration should be given to an examination for sinusitis.

Post-Nasal Drip
Glands in the nose and throat normally produce 1-2 quarts of mucus every day. This mucus moistens the lining of the nose and sinuses, humidifies the air, traps inhaled particles, and helps to fight infections. Normally this mucus is swallowed unconsciously many times throughout the day. When the mucus becomes thick or excessive in volume, it can cause the sensation of post-nasal drip. Post-nasal drainage can often lead to cough, sore throat, frequent throat clearing, and the feeling of a lump in the throat.

An excess in thin, clear secretions can be from viral infections, allergies, spicy foods, temperature changes, pregnancy and some medications (birth control pills, blood pressure medications). Increased thick secretions can occur from low humidity in the winter, a decrease in fluid intake (dehydration), bacterial sinus infections, or from some medications (antihistamines). Swallowing problems or acid reflux can give patients similar symptoms of nasal/throat drainage or phlegm.

A correct diagnosis of the underlying problem is essential to properly treat a patient with post-nasal drip. Treatments for viral infections, allergies, and sinusitis are discussed in other sections. Acid reflux is treated with over-the-counter or prescription medications, depending upon the severity of the symptoms. Other causes are less common and should be thoroughly evaluated by an ENT specialist.

Congestion, stuffy nose, and nasal obstruction
Nasal obstruction can be a considerable nuisance that detracts from the ability of patients to enjoy their normal daily activities. While there are often multiple factors that play a role in any given patient’s congestion, it is easier to understand if the factors are divided into inflammatory causes and structural causes.

Inflammatory causes of nasal congestion and obstruction are due to swelling of the blood vessels in the nasal lining that decreases the nasal airway. A variety of triggers can cause the inflammation of the nasal lining to include viral or bacterial infection (rhinitis or rhinosinusitis), polyps, allergies, pollution or chemical irritants (such as perfume or tobacco smoke), medications, and certain medical conditions (such as pregnancy). Inflammatory or mucosal causes of nasal congestion are best treated with medical therapy, depending upon the specific cause. Antibiotics, topical steroids or decongestants, and antihistamines may all be appropriate. Please see the section regarding each specific cause.

Structural causes of nasal obstruction are due to anatomic abnormalities of bony or cartilaginous areas throughout the nasal airway. Common examples include septal deviation, enlargement of the turbinates, enlargement of tonsils and/or adenoids, nasal deformities, tumors, foreign bodies (such as beads, food and other objects), and congenital problems. Most of these structural causes will not respond to medications and will require surgical therapy for correction. 

Taste and Smell Disorders
Taste and smell disorders affect more than 2 million Americans. These two senses are intimately linked to one another. Most of our sense of taste actually comes from smelling the food we are eating. The taste buds on the tongue have nerve endings that respond to only four tastes – sweet, sour, bitter, and salt. All other “tastes” are a combination of these four basic tastes and our sense of smell. Humans can generally distinguish between four and ten thousand different smells.

There are a number of reasons patients can lose their sense of smell. Nasal obstruction from allergies, viral or bacterial infections, or polyps can prevent odors from reaching the smelling nerves high in the nasal cavity. Viral infections or chemical irritants can also cause direct injury to the smell nerves. Previous surgery or head trauma can also cause nerve damage. As with many of our other senses (vision and hearing) the normal aging process also diminishes our senses of smell and taste. Very rarely, tumors can grow in the nasal cavity and impair the sense of smell.

Your physician may evaluate your smell or taste disturbance by performing nasal endoscopy and/or CT or MRI scans. Unfortunately, most causes of smell/taste disturbance do not have reliable treatments. Things to minimize nasal inflammation, such as avoiding environmental irritants/allergies, stopping smoking, or using topical or oral steroid medication, may improve the symptoms. Damage from prior surgery, head trauma or aging is usually permanent.

Nasal Polyps
Polyps are non-cancerous, grape-like growths that can occur in the nose or sinuses (insert polyp). They are unrelated to polyps that may occur elsewhere in the body (colon or bladder). While the exact cause is unknown, polyps represent the body’s response during an extremely vigorous inflammatory response. They often occur in patients with asthma or allergies. Patients with polyps can suffer from nasal obstruction, decrease in taste or smell and other symptoms of chronic sinusitis. The best medication for treating polyps is oral or topical steroids. These medications can reduce or stabilize the size of the polyps. Unfortunately, once the oral steroids are stopped, the polyps often recur. Surgery (FESS) can be used to remove polyps, but when used alone, it also may be a temporary solution. The best results are generally seen with surgery to remove the bulk of the obstructing polyps and intermittent bursts of oral steroids after surgery to minimize the chances for recurrence. Patients with polyps and asthma will usually have better control of their asthma once their polyps and chronic sinusitis are adequately managed.

Patient Education Interactive Tutorials:
NOTE: In order to view these tutorials, you must have Macromedia Flash installed on your computer.

 Sinus Surgery (Patient Education Institute)- Medlineplus

Other Online Resources:
 Sinusitis (National Institute of Allergy and Infectious Diseases)

 Sinusitis (American Academy of Family Physicians)

 Sinusitis (American Academy of Family Physicians)- Español

 Tips to Remember: Sinusitis (American Academy of Allergy, Asthma, and Immunology)